The impact and user experience of a student-led clinic providing preventative services.

OBJECTIVES: Preventative services are required to address the risk factors for chronic conditions such as cardiovascular disease. The National Health Service Health Checks in England were introduced to provide such services. One School of Pharmacy established a student-led clinic to provide this service to the local community. The clinic was provided by undergraduate pharmacy students and delivered free of charge within a central city locality. The aim was to explore the impact of the clinic on user thoughts and motivations around healthy living and investigate user experience. METHODS: A sequential explanatory mixed methods approach was used consisting of a survey that measured users' thoughts about their health and well-being and experience of the clinic. Qualitative interviews explored the user experience and barriers and facilitators to making healthier lifestyle choices. RESULTS: One hundred and fifty-four members of the public accessed the clinic over the evaluative period. Ninety-six (60%) completed the pre-post survey and 12 participated in follow-up interviews. Users reported statistically significant improvements in how informed, competent and motivated they felt towards making healthier lifestyle choices after the clinic consultation. Interview findings highlighted the positive user experience, reported appreciation for clinic accessibility, availability of healthy lifestyle education, and a desire for more preventative services being as readily available. CONCLUSIONS: The student-led clinic has demonstrated positive impacts on user experience, knowledge, competence, and motivation to make healthier lifestyle choices. The clinic provides proof-of-concept for pharmacy students to deliver preventative community services that aim to improve population health at a time when primary care is experiencing unprecedented challenges.

A qualitative exploration of the barriers and enablers to supporting informal and familial carers within community pharmacies.

OBJECTIVES: There are approximately 5.3 million informal carers in the United Kingdom, many of whom support family in their health despite being unpaid and often unsupported. Many visit pharmacies to collect medicines and look for advice. This work explores informal carer support within community pharmacies (CP). METHODS: Semi-structured video interviews exploring perspectives on the role of CP in supporting carers were conducted in autumn 2022. The study received institutional ethical approval. Interviews were audio-recorded, transcribed verbatim, and analysed using a reflexive thematic approach. KEY FINDINGS: In total 25 interviews were conducted with 13 carers and 12 pharmacy staff. Three themes were identified:-What support do carers need through CP?-medicines management, navigating services, and carers health and wellbeing.-Barriers to CP better supporting carers-relationships with CP, carer needs, identification as a 'carer'.-Enablers to CP better supporting carers-support is a team effort, and CP as a community 'hub'. CONCLUSIONS: There is a trusted relationships between carers and pharmacy staff which can contribute to establishing pharmacies as a safe space of support, this includes medicines-specific support and navigating services, but also carer health and wellbeing support. Pharmacy staff may need to reconsider approaches to identifying and supporting carers and not just treating them as an extension of supporting a patient. In making this support accessible, relationships with pharmacy staff are important, as well as embracing CP as a 'community hub', although pharmacy staff may need training and information to facilitate them in this role.

How cultural competence is conceptualised, developed and delivered in pharmacy education: a systematic review.

BACKGROUND: It is important to have a pharmacy workforce that is culturally competent to recognise a patient's health beliefs to improve medication adherence and reduce poor treatment outcomes. AIM: This systematic review aimed to identify, critically appraise and summarise how cultural competency is conceptualised, developed and embedded in pre-qualification pharmacy education. METHOD: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were searched for relevant papers published in English between January 2012 and December 2021, following PRISMA guidelines. Data from included papers were thematically analysed. Educational quality of papers was appraised using the GREET criteria. This systematic review was registered on PROSPERO, CRD42021295875. RESULTS: The review included 47 papers (46 studies) with 18 papers meeting ≥ 9 points on the GREET criteria thus considered of good educational quality. Forty papers focused on educational interventions implemented to pharmacy students only, the remaining included students from different health disciplines. Half of the educational interventions focused on cultural competence in general. Most educational interventions lasted over a week and 21 were compulsory. Cultural competence conceptualisation varied; a focus on knowledge about different cultures or on culturally competent behaviours or a continuum with knowledge at one end and behaviour at the other. CONCLUSION: There is variation in how cultural competence is embedded in pharmacy programmes, which could be a reflection of the differences in how educators conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it can be embedded in pharmacy education.

The association between marital status and treatment initiation in lung cancer: A systematic review and meta-analysis of observational studies.

Lung cancer is associated with high mortality, and significant health burden. Marital status has been associated with lung cancer survival. This systematic review and meta-analysis set out to investigate the association between marital status and treatment receipt in lung cancer. The search was conducted across three databases: Medline (OVID), Embase and CINAHL, from inception to June 2022. Retrospective or prospective observational studies that quantified treatment receipt by marital status were eligible for inclusion. Study quality was assessed via a modified checklist for retrospective databased-based studies. Meta-analysis using a random effects model was undertaken by chemotherapy, radiotherapy, surgery, and any treatment relative to married or not married. Pooled unadjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated for each type of treatment. 837 papers were screened and 18 met the inclusion criteria with eight being eligible for inclusion in the meta-analysis. Studies were excluded from meta-analysis due to overlap in the data reported in papers; the mean quality score of the 18 included papers was 12/17. Being married was associated with increased odds of overall treatment OR 1.43 (95 % CI 1.14-1.79; I2 = 82 %; Tau2 = 0.07; six studies) and also increased receipt of: chemotherapy 1.40 (95 % CI 1.35-1.44; I2 = 82 %; Tau2 = 0.00); radiotherapy 1.29 (95 % CI 0.96-1.75; I2 = 100 %; Tau2= 0.09; four studies) and surgery (95 % CI 1.31-1.52; I2 = 86 %; Tau2 = 0.00; five studies). The results indicate that those who are married are more likely to receive treatment for lung cancer compared to those who are not married. This requires further investigation to better understand the explanations behind this finding and how we can work to combat this inequality.

Intersectional Identities: Making Sense of Skill Development on Clinical Placements.

OBJECTIVE: Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS: Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS: Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION: Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.

Community pharmacies as a place for informal carer support in mental health and wellbeing.

There are 5.3 million informal carers in the United Kingdom who take on caring responsibilities for family and friends. Informal carers can be forgotten patients within health and care services, yet because of carer burden, they are at risk of deterioration in health and wellbeing. There are higher levels of anxiety, depression, burnout and low self-esteem amongst carers but, to our knowledge work to date has mainly focused on supporting carers to provide better care for their family member, and less on carers' health and wellbeing. There is increasing interest in social prescribing as a method of linking patients with community-based services to improve health and wellbeing. Initiatives have included social prescribing via community pharmacies which are already recognized to be accessible for support and signposting. The coming together of community pharmacy services and social prescribing could represent a framework to better support carers in their mental health and wellbeing.

An orange will do: Suspending learner disbelief in simulations.

INTRODUCTION: Increasingly, educators are implementing simulation to supplement teaching. Where simulation is not already integral, difficulties have arisen with the utilization of simulation due to limited resources, training requirements, and educator uncertainty. PERSPECTIVE: A learner's ability to suspend disbelief in a simulation can impact the effectiveness of learning. In other words, they become so immersed in the simulation that they ignore obvious limitations and choose to believe the activity is realistic. When designing simulations, educators need to consider intended learning outcomes (ILOs), realism, and briefings/debriefings to help learners suspend disbelief. Realism encompasses physical realism (fidelity), conceptual realism, and emotional/experiential realism. The ILOs should drive the simulation design and type of realism required. These should be presented to learners in a briefing, explaining where and why they may need to suspend disbelief; this should be reiterated during a debriefing to centre a learner's focus on whether the ILOs were met. Without this, learners may not "buy into" the simulation and instead can get lost in detail not relevant to their learning. IMPLICATIONS: The use of cutting-edge equipment does not, on its own, ensure that learners get the most realistic learning experience. The goal of simulations should be to utilize resources in the most advantageous manner for attainment of ILOs. In a time when institutions may be pressured for time, staff, and resources, educators should remember that it is possible to facilitate effective learning in low-resource ways.

Identification and evaluation of medication-related issues relating to patient's own drugs by pharmacy students while on placement in a tertiary hospital.

Background Pharmacy students require knowledge of prescribing and supply of medicines; this is achievable through work-based learning. In UK hospitals, pharmacy technicians assess patient's own drugs (PODs) so medicines can be used as they would be at home. Student-led POD checks have not yet been considered as an opportunity for legitimate peripheral participation (LPP). Aim To evaluate an undergraduate pharmacy placement model using POD checking as a way of gaining LPP within a UK tertiary hospital. Method Students (n = 100) attended nine placements over academic year 2020-2021; they were supervised by a pharmacy technician to complete POD checks. Data were collected concerning student activities and resulting medication-related issues (MRIs); data were descriptively analysed. Results 1094 patients were seen by pharmacy students and 296 MRIs identified. Omitted (non-prescribed) medicines were the most common MRI (32.1%), followed by incorrect stock items (16.2%). Most MRIs were medium risk (65.5%). The most common actions/outcomes were handover to another ward member (41.6%) or medication removal (25.3%). Conclusion Clinically relevant MRIs relating to PODs can be identified by pharmacy students while experiencing LPP. These activities illustrate scalable work-based learning where pharmacy students can contribute to patient care in relation to the use and supply of medicines.

Experiencing a virtual patient to practice patient counselling skills.

INTRODUCTION: Virtual patients (VPs) are a safe and standardised method of simulating clinical environments but few studies have explored health care professional's experiences of learning via a VP. This study explored how users experienced and used a VP that aimed to teach the user to deliver non-vitamin K oral anticoagulant patient education. METHODS: The study used semi-structured interviews with pharmacists and pre-registration trainees from a wider research study. Interview topics were based on key areas concerning VP use. Interviews were audio-recorded and transcribed verbatim before being analysed using the framework approach to thematic analysis. Ethical approval was granted by Keele University. RESULTS: There was variation in the type and nature of use of the VP and in the reported learning, which included reinforcement of knowledge, an opportunity to promote reflection, and acquisition and application of knowledge to clinical, patient-facing interactions. The VP was seen as an adjunct to other education and training. The majority of users indicated that they used the VP more than once. Some users seemed to have gamified their learning with a drive to achieve perfect feedback rather than true engagement with the learning, whereas for others the learning appeared to be deep with a reflective focus. CONCLUSIONS: The VP offered an educational use as experiential learning, although the users experienced the VP differently; commonly the VP facilitated learning via reinforcement of pre-existing knowledge. The users reported that the VP had value as an adjunct to other education and training resources.

Exploring the role of pharmacy students using entrustable professional activities to complete medication histories and deliver patient counselling services in secondary care.

Entrustable professional activities (EPAs) allow tasks to be delegated to trainees. A new model of pharmacy placements was developed that used EPAs to appropriately supervise students providing patient counselling for inhalers, anticoagulation and simple analgesia at a tertiary care hospital. Students were provided with clinical communication training (e.g. how to do the counselling) as well as mandatory occupational training (e.g. fire safety). Data was collected (by students and placement facilitators) relating to the number of consultations (n = 1361) and patients who received counselling (n = 308) carried out by students (n = 71) over a 20 week period. Students documented these consultations, recording information such as the patient identification details, subjective and objective history, their assessment of the patients' need, as well as any action taken and any further planned action that was required. These notes were analysed using a Quality and Utility Assessment Framework by three clinical pharmacists. Data was analysed using simple descriptive statistical analysis on Microsoft Excel. Documentation was deemed High Quality (41%), Medium Quality (35%) and Low Quality (24%). The results indicate that pharmacy students can use entrustable professional activities to contribute to clinical services, completing high-quality patient consultations that have utility in clinical practice. Further work is needed to evaluate impact on clinical service delivery and establish the educational utility of using EPAs to support the pharmacy workforce to develop their consultation skills.

Establishing the acceptability and usability of an animated virtual patient simulation.

Background: An animated, video-based, virtual patient (VP) has been developed to allow pharmacists to learn how, and practice how, to advise patients taking non-vitamin K oral anticoagulants, a group of high-risk medicines. VPs are well-established resources but have historically only been accessed within specific online teaching sessions or at university sites; this new VP represents a mobile design that can be accessed from anywhere. Objective: To investigate the usability and acceptability of the VP application with a focus on exploring perspectives on accessibility. Methods: The study used an exploratory sequential mixed method design consisting of a satisfaction survey and interviews. Survey data were analysed descriptively to assess satisfaction with the application and to identify interview discussion areas. Interview data were analysed using the Framework Approach to thematic analysis. Participants were hospital or community pharmacists, or pre-registration pharmacists. Results: A total of 94 survey responses were collected and 22 respondents went on to take part in an interview. Participants reported liking the concept and delivery of the VP, particularly the high-quality technology. They also reported finding it usable, and appeared to favour its mobility and accessibility, particularly as the VP can be used on any internet accessible device, including mobile phones, with no specific requirements. Amendments that were suggested included quickening the delivery of some animations and improving navigation within the application, possibly through a button to return to the previous step should a mistake be made. Conclusions: The mobile VP appeared to be functional and usable, with the majority of users reporting satisfaction with use across a range of devices. Users reported positively about the VP's remote access, but navigation around the application requires development.

Virtual patient technology to educate pharmacists and pharmacy students on patient communication: a systematic review.

Background: Virtual patients (VPs) are a sub-type of healthcare simulation that have been underutilised in health education. Their use is increasing, but applications are varied, as are designs, definitions and evaluations. Previous reviews have been broad, spanning multiple professions not accounting for design differences. Objectives: The objective was to undertake a systematic narrative review to establish and evaluate VP use in pharmacy. This included VPs that were used to develop or contribute to communication or counselling skills in pharmacy undergraduates, pre-registration pharmacists and qualified pharmacists. Study selection: Eight studies were identified using EBSCO and were quality assessed. The eligibility criteria did not discriminate between study design or outcomes but focused on the design and purpose of the VP. All the included studies used different VP applications and outcomes. Findings: Four themes were identified from the studies: knowledge and skills, confidence, engagement with learning, and satisfaction. Results favoured the VPs but not all studies demonstrated this statistically due to the methods. VP potential and usability are advantageous, but technological problems can limit use. VPs can help transition knowledge to practice. Conclusions: VPs are an additional valuable resource to develop communication and counselling skills for pharmacy students; use in other pharmacy populations could not be established. Individual applications require evaluation to demonstrate value due to different designs and technologies; quality standards may help to contribute to standardised development and implementation in varied professions. Many studies are small scale without robust findings; consequently, further quality research is required. This should focus on implementation and user perspectives.

Virtual patient educational programme to teach counselling to clinical pharmacists: development and proof of concept.

Pharmacist-patient counselling can benefit patients and optimise care, but appropriate training is required. A virtual patient (VP) tool to teach pharmacists non-vitamin K oral anticoagulant counselling was developed; the VP may be used for continuing professional development. The objective was to develop and show proof of concept of the VP. A cyclic development approach was adopted whereby the client, developers and a steering group informed VP design, content and aesthetic. This included formal and informal evaluation; ethical approval was not required. The VP received varied feedback. Positive feedback concerned the technology and the high-standard of animations. Negative elements concerned international VP use and differences in practice, also technological comments, regarding VP delivery and usability on various electronic devices. The VP was reported to be 'valuable' and realistic with high-quality animations. The steering group commented on VP's clinical appropriateness, cultural relevance and usability. Areas highlighted for improvement were rectified during development, including the incorporation of printable feedback. European considerations concerned differences in culture and practice. The development process successfully developed the VP and the proof of the concept was demonstrated. This will inform future VP development; a large-scale VP evaluation is underway.